HHS Report Addresses Surprise Billing, No Surprises Act

A new report from the US Department of Health and Human Services (HHS) outlines how the No Surprises Act—which goes into effect in 2022—will affect surprise medical billing practices and what that means for the future of patient care.

According to the researchers in HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) who authored the report, surprise medical bills can average more than $1200 for anesthesiologist services, $2600 for surgical assistants, and $750 for childbirth-related care, which just scratches the service in regards to the out-of-pocket costs patients incur.

“No one should have to worry about going bankrupt after falling ill or seeking critical care,” said Health and Human Services Secretary Xavier Becerra, in a press release. “Today’s report shows that despite some state efforts to tackle surprise medical bills, patients continue to experience exorbitant medical expenses due to lack of transparency and rules.

An approximated 18% of emergency room visits by members enrolled in employer-sponsored plans incurred one or more out-of-pocket charge. The HHS ASPE report found that this percentage varies greatly, ranging from 3% of members in Minnesota to 38% in Texas.

“Another finding in the report is that patients receiving a surprise bill for emergency care paid physicians more than 10 times as much as patients without a surprise bill for emergency care,” said HHS in a press release.

Eighteen states have enacted comprehensive legislation to decrease the practice of surprise billing, with an additional 15 reporting taking partial steps. Some of the ways states work to reduce the practice include establishing standardized payment rates which in turn restricts varied out-of-network vs in network charges. These efforts prove to be more challenging due to the differences among employee-sponsored insurance members vs self-insured members.

Per HHS, “State insurance rules do not apply to self‐insured employee benefit plans, which cover 67% of workers with employer‐sponsored health coverage. Additionally, research has found that some state efforts to resolve surprise billing payment disputes have resulted in increased health care costs.”

Beginning January 1, 2022, new regulations under the No Suprises Act will ensure:

• Individuals with most individual and employer insurance can no longer be balance-billed for emergency and certain non-emergency services in most circumstances.
• Patients will be removed from payment disputes that must be settled between providers and insurers.

The Congressional Budget Office estimates that this updated regulation will reduce payment burdens but lowering insurance premiums. Additionally, the Biden Harris administration is currently accepting comments on an interim final rule regarding resolving disputing claims.